Nursing staff and nursing students' emotions towards homosexual patients and their wish to refrain from nursing, if the option existed

The Mastery of Competencies for the Care of LGBT+ People by Different Health Professionals

This study aims to compare the mastery of competencies in assisting the LGBT+ population of Brazilian health professionals. Data collection occurred in a face-to-face and virtual manner, in the first semester of 2018. The health professionals answered a socio-demographic and functional questionnaire, in addition to the questionnaire Measurement of Training Needs for Health Care for the LGBT+ Public. The data was analyzed using Mann-Whitney and Chi-square tests. The project research was submitted to and approved by the IMED Research Ethics Committee (CAAE 69116917.6.0000.5319). The sample (n= 380) was made up mostly of psychologists (42.3%), female (81%), heterosexual (73.2%), aged between 26 and 35 years (36%), Catholic (41%), living in the south region (36.9%), and working in the profession for ten years or more (34.3%). Skills gaps on the LGBT+ theme was identified, especially in topics such as "approach to the patient's sexuality," "interference of religious beliefs in care," "care with the genitalia and breast of the trans individual," among others. Professionals trained in psychology and non-heterosexuals had a greater mastery of the theme than the others. The fragmentation of knowledge and skills hinders the full and equal access to the health system, and continued educational actions are recommended.

The provision of healthcare services to older LGBT adults in the Nordic countries: a scoping review

OBJECTIVES

Our objectives were to examine what is known about the provision of healthcare services to older LGBT adults in the Nordic countries, identify knowledge gaps, map implications of this research for the education of healthcare professionals and delivery of healthcare, and identify key future research priorities to advance policy and practice for older LGBT adults in this region.

DESIGN

We conducted searches in nine databases. Peer-reviewed articles and PhD theses published in and after 2002 written in English, Norwegian, Swedish or Danish languages were included. 41 studies met our inclusion criteria. However, only eight of these studies focused specifically on older LGBT adults. Therefore, to answer all research questions, five book chapters about older groups were also included.

RESULTS

There were few studies from countries other than Sweden and few quantitative studies. Bisexual people represented a neglected group in research. The studies included showed that healthcare personnel lack knowledge on LGBT issues, particularly about older LGBT adults and non-binary gender identification. Older LGBT adults frequently reported being met with cis- and heteronormative expectations in healthcare encounters. For transgender people, access to medical treatment has been managed by gatekeepers influenced by a binary understanding of gender.

CONCLUSIONS

Relevant measures to enhance practices are increased attention on LGBT issues in education; training of healthcare professionals; measures at the institutional level; and ensuring that transgender people identifying as non-binary receive the same quality of care as individuals identifying in a binary way.

The Scope of LGBTQIA+ Health Content in Prelicensure Nursing Curricula

BACKGROUND

Little is known about the status of lesbian, gay, bisexual, transgender, queer or questioning, and inter-sex and asexual (LGBTQIA+) health content in prelicensure nursing curricula. This study explored curricular and pedagogical practices of LGBTQIA+ health content in nursing curricula in the United States.

DESIGN

A quantitative, cross-sectional comparative descriptive design was implemented.

METHOD

Stratified random sampling was used to email a survey to deans and administrators of prelicensure associate degree in nursing (ADN) and baccalaureate nursing (BSN) programs.

RESULTS

Private ADN programs included more LGBTQIA+ health content than BSN programs and more LGBTQIA+ health content than public ADN programs in nursing curricula.

CONCLUSION

Although progress has been made to include LGBTQIA+ health content in nursing curricula in the U.S., creative educational strategies can be used to help meet the varying needs of different programs. [J Nurs Educ. 2023;62(11):623-630.].

Violence Against LGBTIQ+ People at Universities: The Need to Uncover a Silent Reality

Violence against LGBT community can manifest in different forms and exists in all spheres of society, including education. The main purpose of this article is to deepen the understanding of the state of the art about violence grounded in sexual orientation or gender identity in higher education in order to identify gaps for further research. The topic of this state-of-the-art literature review is the presence and magnitude of these forms of violence in the Spanish higher education system. For this reason, the inclusion criteria were empirical studies about the prevalence of violence against LGBTIQ+ individuals in the Spanish educational system. After analyzing the 25 articles that met the inclusion criteria, the main findings point that despite the existence of numerous international studies of the presence of violence against LGBTIQ+ people at colleges, little is known about this reality in Spain. The Spanish university system continues to remain hermetic, and violence against LGBTIQ+ people is silenced and hidden. Practice, policy and research implications of the findings are discussed in this article, highlighting the need of further research in this field. In this context, the research project Uni4Freedom, addresses this social and educational problem to contribute to the creation of safer universities for the LGBTIQ+ community and people who support them.

Continuing education with a holistic approach to the Brazilian LGBT+ population through use of the m-health App

AIM

This article aims to discuss the development of a continuing education course for health care professionals to provide competent healthcare assistance to the Brazilian LGBT+ population and the implementation of this course using a m-Health solution.

BACKGROUND

There is a scarcity of continuing education courses in the Brazilian context that update provides evidenced-informed education to ensure health care professional competence in the delivery of health care to LGBT+ individuals.

METHODS

Based on Bloom's taxonomy, with a main focus on the cognitive domain, the course "Ally: A Holistic Approach to the LGBT+ Individual'' was developed in five months. This was based on the Nurse's Health Education for LGBT Seniors (HEALE), the Curriculum Implementation and Institutional Climate manual, Changes to Improve Healthcare for LGBT People, Gender Nonconforming or Born with DSD" and the National Comprehensive Health Policy for LGBT+ People, among others.

RESULTS

Comprising six modules: i) human sexuality; ii) equitable care and appropriate terminology; iii) public health policy for the LGBT+ population; iv) cultural skills for health professionals; v) aging and health care for the LGBT+ population; and vi) mental health of LGBT+ people. Content validity indexing was established using an expert panel and was Ally was supported by a m-Health Solution called "Over the Rainbow'' and totals of 60 h of education.

CONCLUSIONS

This m-Health solution and continuing education course for health professionals can be an opportunity to change health professionals' practice to offer more equitable health care for the LGBT+ population.

Review of current 2SLGBTQIA+ inequities in the Canadian health care system

Gender identity and sexual orientation are determinants of health that can contribute to health inequities. In the 2SLGBTQIA+ community, belonging to a sexual and/or gender minority group leads to a higher risk of negative health outcomes such as depression, anxiety, and cancer, as well as maladaptive behaviors leading to poorer health outcomes such as substance abuse and risky sexual behavior. Empirical evidence suggests that inequities in terms of accessibility to health care, quality of care, inclusivity, and satisfaction of care, are pervasive and entrenched in the health care system. A better understanding of the current Canadian health care context for individuals of the 2SLGBTQIA+ community is imperative to inform public policy and develop sensitive public health interventions to make meaningful headway in reducing inequity. Our search strategy was Canadian-centric and aimed at highlighting the current state of 2SLGBTQIA+ health inequities in Canada. Discrimination, patient care and access to care, education and training of health care professionals, and crucial changes at the systemic and infrastructure levels have been identified as main themes in the literature. Furthermore, we describe health care-related disparities in the 2SLGBTQIA+ community, and present available resources and guidelines that can guide healthcare providers in narrowing the gap in inequities. Herein, the lack of training for both clinical and non-clinical staff has been identified as the most critical issue influencing health care systems. Researchers, educators, and practitioners should invest in health care professional training and future research should evaluate the effectiveness of interventions on staff attitudinal changes toward the 2SLGBTQIA+ community and the impact on patient outcomes.

The Binary Order of Things: A Discursive Study of Nursing Students' Talk on Providing, and Learning About, LGBT Patient Care

Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.

LGBTQIA+ invisibility in nursing anatomy/physiology textbooks

Members of the LGBTQIA+ experience health disparities that are compounded by providers that lack cultural competence, i.e., the skills, attitudes, and knowledge to offer culturally sensitive care. Educational efforts focus on increasing LGBTQIA+ representation across undergraduate nursing curricula and the recruitment and retention of members of this community into nursing programs. However, the ways that classroom materials represent LGBTQIA+ people can perpetuate social norms rather than accurate scientific understandings, thus limiting students' development of cultural competence while also driving LGBTQIA+ students from nursing. This study performs a content analysis for LGBTQIA+ inclusion in four widely adopted undergraduate nursing anatomy/physiology textbooks. We identify specific social beliefs that exclude LGBTQIA+ people and compare the different ways these manifested in each of the four textbooks. We argue that the way these books represent LGBTQIA+ people violate the fundamental ethical principles of nursing. Based on our findings, we challenge educators to consider the impact that language, images, and other classroom materials have on LGBTQIA+ students and all students' ability to develop cultural competence.

Attitudes toward Homosexuality among Nurses in Taiwan: Effects of Survey Year and Sociodemographic Characteristics

This study aimed to compare the level of attitudes toward homosexuality among nurses in Taiwan between 2005 and 2017 and with various demographic characteristics, as well as the roles of demographic characteristics in the changing trend of attitudes toward homosexuality between 2005 and 2017. This survey study recruited nurses from three hospitals in 2005 (Survey 2005, N = 1176) and 2017 (Survey 2017, N = 1519). Participants’ four dimensions of attitudes toward homosexuality, including condemnation, immorality, avoiding contact, and stereotypes, were assessed using the Taiwanese version of the Attitudes Toward Homosexuality Questionnaire. The results demonstrated that nurses in 2017 exhibited lower levels of avoiding contact with lesbian and gay patients and stereotypes toward homosexuality but higher levels of condemnation of gay and lesbian individuals and perceptions of gay and lesbian individuals as immoral than did nurses in 2005. Age moderated changes in some dimensions of attitudes toward homosexuality from 2005 to 2017. The need to develop training programs aimed at improving not only the quality of nursing skills but also their negative attitudes regarding homosexuality is urgent.

Does Location of Practice or Religiosity Predict Negative Physician Attitudes or Beliefs Toward LGB+ Individuals?

The purpose of this study is to extend the Sabin et al's. (Am J Public Health 105(9):1831-1841, 2015. https://doi.org/10.2105/AJPH.2015.302631) findings to examine the extent to which religiosity and/or geographic region is predictive of negative attitudes or beliefs toward lesbian, gay, bisexual, and asexual (LGB+) individuals. Secondary data from the Sexuality Implicit Association Test were analyzed. Data included only participants from 2013 to 2015 who identified "Healthcare - Diagnosing and Treating Practitioners" as their occupation (n = 1376). The results of a factorial ANOVA revealed significant group differences accounting for 22.4% of the variance in attitudes toward LGB+ individuals. Religiosity was a significant factor in determining negative attitudes toward LGB+ individuals. However, the study was underpowered (5.8%) to detect an effect of geographic location in determining negative attitudes toward LGB+ individuals. It is important to validate a tool that can adequately measure the common assumptions associated with both religion and geographic region. Additionally, medical educators need to learn how to recognize and address negative attitudes among their students.

A Systematic Review of the Discrimination Against Sexual and Gender Minority in Health Care Settings

The present systematic review aimed to determine discrimination experiences of sexual and gender minority (SGM) individuals and attitudes toward SGM among health care staff in health care settings. Following PRISMA guidelines, the review was conducted in 3 databases (PubMed, Cochrane Library, Science Direct) using keywords of sexual and gender minority, including “gay,” “lesbian,” “bisexual,” “transgender,” “LGB,” “LGBT,” “health care discrimination,” “stigma,” “homophobia,” “transphobia,” and “attitudes of healthcare professionals” from May to September 2016. Predetermined inclusion criteria were selected. Thirty quantitative studies were eligible for inclusion in this review. Discriminative behaviors experienced by SGM individuals were stigma, denial or refusal of health care, and verbal or physical abuse. Knowledge and educational levels, beliefs, and religion of health care providers affected their attitudes toward SGM patients and their homophobia level. These findings revealed that health care providers needed more education about SGM issues, and SGM-friendly policies should be created for improving health care for SGM individuals.

Cultural competency and microaggressions in the provision of care to LGBT patients in rural and appalachian Tennessee

PURPOSE

Lack of provider training in lesbian, gay, bisexual, and transgender (LGBT) cultural competence may diminish healthcare access. Culturally competent providers may enact microaggressions when providing LGBT patient care, especially in sociopolitically conservative areas. Our study examined LGBT cultural competence and microaggressions among healthcare providers in rural Tennessee.

METHODS

Providers (n = 85) completed a self-report survey on LGBT cultural competence. Post-survey, we invited respondents to provide an interview to contextualize quantitative findings and identify barriers to LGBT patient care (n = 6).

RESULTS

Most quantitative respondents disagreed that they preferred not to care for LGBT patients (85.9%) or that they would refuse care to LGBT patients (92.9%). Only half felt competent to provide LGBT patient care (54.1%). Fewer oncology than primary care providers felt competent treating LGBT patients, and more physicians than nurses reported their training did not adequately address LGBT issues. Qualitatively, interviewees reported serving patients "equally", yet described discomfort with LGBT patients and LGBT microaggressions in clinical practice.

PRINCIPAL CONCLUSIONS

While many providers felt competent to provide LGBT patient care, they described behaviors and attitudes that may contribute to LGBT healthcare inequities.

PRACTICE IMPLICATIONS

Provider training must address how microaggressions negatively influence patient-provider interactions and LGBT patient care.

LGBTQ competence wanted: LGBTQ parents' experiences of reproductive health care in Sweden

BACKGROUND

It is the responsibility of reproductive healthcare professionals to support all lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents in their transition to parenthood. LGBTQ parents may not be fully supported within the reproductive health sector, because of heteronormativity and healthcare professionals' attitudes and practices. Beyond same-sex mothers, no research has been conducted in Sweden on the broader group of LGTBQ parents.

AIM

To explore LGBTQ expectant and new parents' experiences of reproductive health care in Sweden when becoming parents.

METHOD

The current study consisted of cross-sectional qualitative interviews and was conducted using a semi-structured interview guide. Interviews were transcribed verbatim and analysed using systematic text condensation according to Malterud.

RESULTS

The convenience sample consisted of 12 LGBTQ expectant or new parents. Four themes emerged from the analysis: (i) Inadequacies and mistreatment in reproductive health care, (ii) Consequences of heteronormativity, (iii) Satisfaction with reproductive health care despite heteronormativity and (iv) Wishing for LGBTQ competent reproductive health care. The first two themes concerned different heteronormative barriers in reproductive health care and the consequences for LGBTQ parents, which also included intersecting forms of judgment and mistreatment. The third theme highlighted the participants' satisfaction with LGBTQ competent care and aspects of high-quality care, despite lacking support. The last theme described the participants' wishes for inclusive and LGBTQ competent care and what reproductive healthcare professionals can do to achieve LGBTQ competence.

CONCLUSIONS

Heteronormativity in the reproductive health sector is widespread and leads to lacking support in the transition to parenthood for LGBTQ people. Swedish reproductive health professionals may benefit from interventions aimed at developing LGBTQ competence. Reproductive healthcare professionals need to develop professional interventions to support and facilitate LGBTQ parents' transition to parenthood.

The emotion of compassion and the likelihood of its expression in nursing practice

Philosophical and empirical work on the nature of the emotions is extensive, and there are many theories of emotions. However, all agree that emotions are not knee jerk reactions to stimuli and are open to rational assessment or warrant. This paper's focus is on the condition or conditions for compassion as an emotion and the likelihood that it or they can be met in nursing practice. Thus, it is attempting to keep, as far as possible, compassion as an emotion separate from both moral norms and professional norms. This is because empirical or causal conditions that can make experiencing and acting out of compassion difficult seem especially relevant in nursing practice. I consider how theories of emotion in general and of compassion in particular are somewhat contested, but all recent accounts agree that emotions are not totally immune to reason. Then, using accounts of constitutive conditions of the emotion of compassion, I will show how they are often likely to be quite fragile or unstable in practice and particularly so within much nursing practice. In addition, some of the conditions for compassion will be shown to be problematic for nursing practice. It is difficult to keep ideas of compassion separate from morality, and this connection is noticeable in the claims made of compassion for nursing and so I will briefly highlight one such connection that of the need for normative theory to give an account of the value that emotions such as compassion presume and that compassionate motivation is separate from moral motivation and may conflict with it. The fragility or instability of the emotion of compassion in practice has implications for both what can be expected and what should be expected of compassion; at least if what is wanted is a realist rather than idealist account of "should."

Nursing Students' Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Persons: An Integrative Review

AIM

The aim of this study was to critically appraise and synthesize findings from studies on the attitudes of nursing students toward lesbian, gay, bisexual, and transgender (LGBT) persons.

BACKGROUND

There is paucity of research to assess the attitudes of nursing students toward LGBT persons.

METHOD

An electronic search was conducted using PubMed, Medline, Web of Science, EbscoHost, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature using medical subject headings terminologies. Search terms used included gay, lesbian, transgender, bisexual, LGBT, nursing students, baccalaureate nursing, undergraduate nursing, homophobia, homosexuality, sexual minority, attitudes, discrimination, and prejudice.

RESULTS

Less than 50 percent of the studies (5 out of 12) suggested positively leaning attitudes of nursing students toward LGBT persons; six studies reported negative attitudes, and one study reported neutral attitudes.

CONCLUSION

There are some indications that student attitudes may be moving toward positively leaning. Studies published before 2000 reported a preponderance of negative attitudes.

Is being gay bad for your health and wellbeing? Cultural issues affecting gay men accessing and using health services in the Republic of Ireland

This paper examines how the experience of cultural inequalities affects the health and wellbeing of gay men in the Republic of Ireland. Gay men experience discrimination in the cultural domain when accessing and using the health services in Ireland that reinforce heteronormative values and preferences. Health inequalities experienced by gay men in the Republic of Ireland are strongly influenced by cultural factors: the Catholic Church, institutional heterosexism, heteronormativity and homophobia, which create a stigmatised identity among gay men and have an adverse effect on health and wellbeing. Counteracting cultural inequalities for gay men accessing and using health care services in Ireland requires a commitment to better education, continued funding for dedicated health services for gay men and the creation of an environment of acceptance where health services are provided.

"Never in All My Years... ": Nurses' Education About LGBT Health

In spite of recent calls for patient-centered care and greater attention to the needs of lesbian, gay, bisexual, and transgender (LGBT) patients, nurses still lack basic education about LGBT patient care and, as a result, may have negative attitudes, endorse stereotypes, and/or feel uncomfortable providing care. This study reports on education/training of practicing nurses and explores some of the reasons for nurses reporting feelings of discomfort with LGBT patient care. Transcripts from structured interviews with 268 nurses in the San Francisco Bay Area revealed that 80% had no education or training on LGBT issues. Although most said they were comfortable with LGBT patient care, some of their comments indicated that they might not be providing culturally sensitive care. Implications for nursing education and for policies and procedures of health care institutions are addressed.

Nursing students' perceptions of their knowledge of lesbian, gay, bisexual, and transgender issues: effectiveness of a multi-purpose assignment in a public health nursing class

Nurses work with diverse populations, but the nursing literature lacks research, theoretical frameworks, or practice guidelines regarding lesbian, gay, bisexual, and transgender (LGBT) health. Through diverse teaching strategies, students explored issues related to LGBT patients, families, and nurses using a cultural humility lens. Diverse teaching strategies included readings, a 2-hour presentation on LGBT health issues, and an assignment to conduct a scripted interview with two nurse key informants, based on the Health Care Equality Index (HEI). Students completed an online LGBT awareness preinterview survey, completed interviews, and completed a postinterview survey. Students showed a significant increase in knowledge about sexual orientation and gender identity and research and interview methods from pretest to posttest. The diverse teaching strategies involved in this assignment can enhance student knowledge, attitudes, and skills related to LGBT health care needs and increase appreciation of nursing research.

Assessing undergraduate nursing students' knowledge, attitudes, and cultural competence in caring for lesbian, gay, bisexual, and transgender patients

Lesbian, gay, bisexual, and transgender (LGBT) patients experience barriers to health care that include fear of discrimination, as well as insensitivity and lack of knowledge about LGBT-specific health needs among providers. This study examined the effectiveness of an educational intervention designed to improve knowledge and attitudes of baccalaureate nursing students regarding LGBT patient care. Education focused on key terminology, health disparities, medical needs of transgender patients, and culturally sensitive communication skills for competent LGBT patient care. Knowledge level and attitudes were evaluated before and after the intervention using a survey based on a modified Attitudes Toward Lesbians and Gay Men Scale and two assessment tools developed for this study. A statistically significant increase in positive attitudes and knowledge level was found immediately after the intervention. Findings from this study support the inclusion of education related to LGBT patient health care in undergraduate nursing curricula to promote cultural competence and sensitivity.

Lesbian women's experiences with healthcare providers in the birthing context: a meta-ethnography

OBJECTIVE

to explore research knowledge about lesbian women's experiences with health-care providers in the birthing context.

METHOD

a systematic search for relevant qualitative studies in selected databases identified 13 articles of sufficient quality. The findings were synthesized using a meta-ethnographic approach as described by Noblit and Hare. SYNTHESIS AND FINDINGS: issues related to covert or overt homophobia and prejudice were demonstrated and were sometimes mediated by subtle mechanisms that were difficult to understand and to manage. On the other hand, small gestures of support were described to make a huge difference. A lack of knowledge was demonstrated, contrasted by staff showing a positive and informed attitude. Disclosure was an important issue, but due to the risk involved the women demonstrated a need to be in control. Finally, being acknowledged, both as individuals and as family were considered vital. In this regard, it was essential to recognize and include co-mother as equal parent and to look upon lesbian sexuality as normal and natural.

KEY CONCLUSIONS

midwives' emotional involvement in the situation is significant for moral perception of the women's intimate citizenship, even when they are distressed by lesbian sexuality.

IMPLICATIONS FOR PRACTICE

our findings reveal the importance of including sexuality as an issue deserving reflection in maternity wards, whether or not this might cause unrest in midwives who do not feel comfortable with intimate citizenships beyond mainstream.

Out lesbians in nursing: what would Florence say?

Research and education on lesbian health has increased substantially in quantity and quality in the past 40 years, but little of this work has been produced by nursing scholars. We began our academic nursing careers as out lesbian faculty at the same college of nursing in the late 1980s, where we collaborated on the earliest studies of attitudes about lesbians in the nursing profession. Our paths diverged in the early 1990s, but we shared similar experiences in nursing education that highlight the structural and attitudinal barriers within nursing that have inhibited lesbian health studies. The deeply imbedded lesbian phobia within nursing has historic roots that plague contemporary research, education, and practice. In this article, we discuss the inclusion of lesbian health in nursing, share some of our personal stories about the obstacles we encountered, and end with suggestions for changing this stifling climate for future generations of lesbian health scholars.

Lesbian, gay, bisexual, transgender, and queer/questioning nurses' experiences in the workplace

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) nurses constitute one of the largest subgroups within the profession of nursing, yet there is very little empirical research in the nursing literature and virtually no attention to issues of discrimination and exclusion in the workplace by nursing education or professional nursing organizations. This study reports the findings of an online survey of 261 LGBTQ nurses from a database of an LGBTQ health advocacy organization. The survey contained both quantitative and qualitative items and revealed that many workplaces lacked policies and procedures that would make LGBTQ nurses feel safer and more included and that many coworkers, supervisors, and patients had exhibited discriminatory behavior or verbal harassment, sometimes leading to significant consequences for the LGBTQ worker. LGBTQ nurses expressed a need for a professional organization that would educate the nursing profession and the general population about LGBTQ issues and address their advocacy and health care policy needs. Efforts to correct the current workplace climate for LGBTQ employees would involve (a) changes in workplace policies, (b) education of the health care workforce, and (c) advocacy from nursing professional organizations.

Using psychodynamic small group work in nurse education: closing the theory-practice gap?

This paper illustrates the role of psychodynamic small group work in integrating theory and practice for nursing students. Psychodynamic work with individual patients and small staff groups is established in some areas of medical and nursing practice although not widely used in general nursing. Clinical material which was brought to two group supervision sessions by student nurses on clinical placement is presented in this paper and discussed using a psychodynamic perspective. A critical review of psychodynamic small group work and a position paper is presented in this paper to argue that using a psychodynamic approach in nurse education may address the theory-practice gap for student nurses by allowing them to reflect on the emotional issues arising in clinical placements. The paper illustrates how supervision can assist students to integrate theory and practice. It is suggested that reflecting on feelings in small group work with student nurses with a tutor or supervisor who works psychodynamically may help students integrate their theoretical and practical learning. Understanding the theory-practice gap from a psychodynamic perspective may help nurse tutors in their personal tutor work to integrate theoretical and practical learning for students and thereby support students in providing good quality care for their patients.

Knowledge, attitudes, perceived vulnerability of Chinese nurses and their preferences for caring for HIV-positive individuals: a cross-sectional survey

AIMS

The study was to assess HIV/AIDS knowledge, attitudes and perceived vulnerability with potential factors.

BACKGROUND

HIV/AIDS is a public health catastrophe in China. Nurses are expected to care for nurture, comfort and advocate for all patients regardless of their condition. However, in the area of HIV/AIDS, nurses suffer as a result of expectations put on them by their professional roles.

DESIGN

This was a descriptive, cross-sectional design that used a survey approach.

METHOD

Data were collected from Summer 2003-Winter 2004.

RESULTS

Nurses reported significant perceived severity of risk from occupational exposure. Many nurses were frequently exposed to being stuck by needles (86%) and being splashed by body fluids and more than half of them (59.7%) were concerned about contracting HIV/AIDS. Nurses who had experience of finger pricks worried about potentially contacting HIV and being unaware of it (odds ratio= 0.444, p = 0.004). Nurses demonstrated a lack of knowledge and training in infectious diseases which may be a result of the fact that the study location is not considered a 'concentrated area' for infectious disease transmission; therefore, the need for the infectious diseases training has not been considered urgent.

CONCLUSIONS

A well-designed educational programme on occupational hazards and risk behaviour should be implemented to educate nurses in suburban cities and the general public. Hospital administrators should implement on-site continuing education on HIV/AIDS throughout China. Armed with better knowledge of both transmission routes and precautions, nurses can protect themselves while providing care to patients.

RELEVANCE TO CLINICAL PRACTICE

Nurses in China urgently need psychosocial and physical supports from families, friends, communities and their working environments while combating HIV epidemic. With good support system, nurses will better educate patients and their family members on how to prevent transmission not only of HIV/AIDS but of a wide range of other infectious diseases as well.

Homofobia en estudiantes de enfermería

La homofobia es una actitud negativa hacia personas homosexuales, frecuente en profesionales de la salud y con implicaciones en la salud pública. Este fenómeno había sido poco estudiado en estudiantes de enfermería. El objetivo fue conocer la prevalencia y las variables asociadas a la homofobia en estudiantes de enfermería. La revisión sistemática fue realizada de los artículos de investigación formal en EBSCO, Imbiomed, LILACS, MEDLINE, Ovid y ProQuest. Fueron incluidos los artículos publicados entre 1998 y 2008, escritos en español, inglés o portugués. Fueron utilizadas las palabras llave homophobia, homosexuality y nursing students. Se realizó un análisis descriptivo. Se revisaron ocho investigaciones. Entre el 7 y el 16% de los estudiantes presenta algún grado de homofobia. La homofobia es más común en varones y en los religiosos más conservadores. La homofobia es frecuente en estudiantes de enfermería y puede tener implicancias negativas para el ejercicio de la enfermería.

To hide or not to hide, that is the question! Lesbians and gay men describe experiences from nursing work environment

Homosexual nursing staff (n = 21) from different parts of Sweden were interviewed about experiences from their psychosocial work environment and about what they consider important points to communicate about lesbians and gay men in nursing. The findings show that most of the informants were partly open about their sexual orientation at work, the women less so than the men. All informants spoke of the fear of being socially excluded. Reported negative experiences included being neglected, harassment, and verbal discomfort based on sexual prejudices. The informants regarded responsibility, the need for knowledge, the consequences of invisibility, and the lesbian's specific situation, important points to communicate regarding homosexuality and nursing.

Heterosexual assumptions in verbal and non-verbal communication in nursing

AIM

This paper reports a study of what lesbian women and gay men had to say, as patients and as partners, about their experiences of nursing in hospital care, and what they regarded as important to communicate about homosexuality and nursing.

BACKGROUND

The social life of heterosexual cultures is based on the assumption that all people are heterosexual, thereby making homosexuality socially invisible. Nurses may assume that all patients and significant others are heterosexual, and these heteronormative assumptions may lead to poor communication that affects nursing quality by leading nurses to ask the wrong questions and make incorrect judgements.

METHOD

A qualitative interview study was carried out in the spring of 2004. Seventeen women and 10 men ranging in age from 23 to 65 years from different parts of Sweden participated. They described 46 experiences as patients and 31 as partners.

FINDINGS

Heteronormativity was communicated in waiting rooms, in patient documents and when registering for admission, and nursing staff sometimes showed perplexity when an informant deviated from this heteronormative assumption. Informants had often met nursing staff who showed fear of behaving incorrectly, which could lead to a sense of insecurity, thereby impeding further communication. As partners of gay patients, informants felt that they had to deal with heterosexual assumptions more than they did when they were patients, and the consequences were feelings of not being accepted as a 'true' relative, of exclusion and neglect. Almost all participants offered recommendations about how nursing staff could facilitate communication.

CONCLUSION

Heterosexual norms communicated unconsciously by nursing staff contribute to ambivalent attitudes and feelings of insecurity that prevent communication and easily lead to misconceptions. Educational and management interventions, as well as increased communication, could make gay people more visible and thereby encourage openness and awareness by hospital staff of the norms that they communicate through their language and behaviour.

Health care barriers and same-sex intimate partner violence: a review of the literature

Minority groups experience barriers to accessing and receiving health care. Sexual minorities, which include gay men and lesbians, have no specific defining physical characteristics and are not as easy to identify as other minority groups. Consequently, their unique health care disparities are frequently overlooked. Myths and facts regarding the common barriers to health care, including those specific to same sex intimate partner violence, are explored.